Drug Interactions between emtricitabine / nelfinavir / tenofovir disoproxil and sirolimus topical

MONITOR: Sirolimus may be systemically absorbed following topical administration. Theoretically, coadministration with inhibitors of CYP450 3A4 may increase the systemic exposure of sirolimus, which is a substrate of the isoenzyme. Significant increases in systemic exposure have been reported when oral sirolimus was coadministered with potent and moderate CYP450 3A4 inhibitors such as azole antifungal agents, macrolide antibiotics, protease inhibitors, and some calcium channel blockers. No formal studies to evaluate drug interactions with topical sirolimus have been conducted.

MANAGEMENT: Caution is advised if topical sirolimus is prescribed with potent or moderate CYP450 3A4 inhibitors. Patients should be monitored for systemic sirolimus adverse effects including immunosuppression, infection, hyperlipidemia, malignancy, and interstitial lung disease.